Handle with care: how to future-proof your fertility

Whether babies are very much on your mind or something that you might think about some day, the idea of future-proofing your fertility is appealing. Stylist investigates the options. Words: Charlotte Haigh. Photography: Dennis Pedersen.

Fertility is always a talking point. Regardless of where your head is at – actively trying for a baby, keen but not in a position to try, debating whether you want children at all or struggling with fertility issues – society places so much expectation on women to procreate.

But the good news is that everyone is talking about fertility more and more. Even as recently as five years ago, the line seemed definite: you either could, or you couldn’t have children and there was little in between. But there’s more information now, more services being offered to women and more honesty around the topic which gives us the power to reclaim fertility – away from the headlines, guilt and confusion.

Fertility – and eggs – has been prominent in my mind over the last decade or so. My journey has been complex – and very emotional. I always longed for a family and went freelance aged 29, thinking it would be easier to juggle self-employed life with children, when I had them. Unfortunately, what I didn’t have was a partner who wanted to have a baby with me. Single for most of my 20s and early 30s, by the time I married, at 36, I was terrified it was too late because of all the stats that were being thrown around in the tabloids (which I now know to be over-exaggerated). But it’s stressful to keep hearing those stats – even if you already have kids and want more, let alone if you’ve not started a family, or even sure if you want kids.

The British Pregnancy Advisory Service (BPAS) has found over half of women aged 30 to 34 worry they’re running out of time to have a healthy pregnancy. But part of the problem and wider misunderstanding around the topic is that we’re not always in a position to do anything about it – as much as we may wish we were. And likewise, not everyone wants to have a child with a partner, or at all right now – but that doesn’t mean they might not change their mind in the future.

Last year, a report by BPAS cited complex reasons for delaying starting a family, including lack of a stable relationship and financial worries, but there are myriad reasons why you may not want to, or think about, starting a family. And having stats about declining fertility hanging over you, incessant pictures of babies popping up on Facebook or people asking, “When are you going to have kids?” can feel intrusive.

There are so many sensitive complexities to fertility and now, at 42, I know I probably panicked too soon at 36. While fertility does start to slide when you get older, it turns out the statistic that it’s all over for your eggs after 35 is largely based on 300-year-old French church records, from a time when couples were less healthy and probably trying to avoid conception – and it’s not the dramatic drop we’ve been led to believe.

“While fertility does start to drift downwards in your mid-30s, most women would still conceive at that age,” says Nicholas Raine-Fenning, clinical associate professor and reader in reproductive medicine and surgery at the Queen’s Medical Centre in Nottingham. “One piece of research suggested that within two years of actively trying to conceive, women aged 35 had an 87% chance, while 67% of 38-year-olds got pregnant.” We know that realistically too – we’ve all got friends who conceived in their late 30s and early 40s.

But conceiving does take longer the older you are and that is a reality – you have fewer quality eggs towards your later 30s, so each month there’s a lower chance the mature egg your ovaries produce will be good enough to fertilise. So at 40, you have a 5% chance of conceiving per cycle, compared with a 20% chance at 30. That doesn’t mean it’s impossible – just that it’s likely to take longer. However, things change rapidly as you move through your 40s – by 45, most women will have few fertility-quality eggs left – so that is a very definite drop off for natural conception.

There’s no escaping the reality that it’s better to try in your early 30s – along with improved chances of conception, you’ll be at lower risk of chromosomal abnormalities and miscarriage. Sadly, I lost two pregnancies – the first probably due to a chromosomal abnormality, the other in the second trimester for a reason that boiled down to pure bad luck, not age. As I was almost 40 by then, it didn’t leave much time for me to conceive again.

So, from both personal and professional experience, as a health writer for some 15 years, these are ways to future-proof fertility for modern women who aren’t ready to make the call just yet.

Seven ways to future-proof your eggs

Here are the things you need to know – minus the scare tactics – to protect your fertility for the future. Just in case you need it…

1. Find your fertility blockers now

You can have tests to check for fertility issues at any age, and they’re available at many private clinics (see guide.hfea.gov.uk for more info). They cost around £200 on average and help pinpoint problems long before you start trying to get pregnant.

“You can have your fallopian tubes assessed for blockages with an ultrasound scan that can also check your womb and ovaries for endometriosis, fibroids, polyps or ovarian cysts, which can usually be treated to improve your chances when the time comes to try to conceive,” says Raine-Fenning.

Many women have these conditions and still have children – but knowing about them means you can look into treatments and ways to help ease the symptoms that are affecting you now.

2. Seeing into your fertility future

Some women’s fertility drops off in their 30s, some in their 40s – and it’s due to ovarian egg reserves. “Fertility clinics can offer a blood test to measure your anti-Mullerian hormone (AMH) levels, to show roughly how many eggs you have left, and a scan can also count how many follicles or eggs you produce each month – together they give you an indication about whether you should try to conceive sooner rather than later,” says Raine-Fenning.

Unfortunately, there’s nothing that will tell you the exact age you might run out of eggs, but you can take an AMH test at home (£140, from zitawest.com) – but be aware that this testing has its limits.

“It doesn’t tell you about egg quality and that’s often what causes problems in women over 35, even if your ovarian reserve is good,” says Raine-Fenning. “Age is still the biggest indicator. Conversely, low AMH doesn’t mean you can’t conceive, providing you’re still ovulating every month and your tubes aren’t blocked. My advice? Testing your AMH may be helpful if you’re trying to decide whether to go for it now or wait for a while. But if you’re not in a position to start a family yet, it can be falsely worrying or falsely reassuring, so don’t over-rely on it.”

3. Consider putting your eggs on ice

Tech companies including Facebook and Apple offer to pay for their employees to do this as a means to keep valuable staff in positions for longer – and give them more options. Doctors use IVF drugs to stimulate the ovaries, collect the eggs and freeze the mature ones, so it’s not an easy procedure to go through physically, or a cheap one – a cycle can cost up to £5,000, and you may need more than one. When you’re ready to use the eggs, they’re defrosted and fertilised with your partner’s sperm.

Egg freezing once had a reputation for being unreliable but, says Professor Dr Geeta Nargund, medical director of Create Fertility, techniques have improved. “Vitrification – also known as flash or fast-freezing – is the latest technology for freezing,” she says. “It uses an ultra-rapid cooling system which avoids the formation of potentially cell-damaging ice crystals, and that contributes to higher survival rates when the eggs are thawed. We also use safer, milder techniques to stimulate the ovaries to produce eggs which helps us get better quality eggs.”

The number being thawed and used is still tiny (816 women froze their eggs in 2014 in the UK) and so far success rates are lower than IVF using fresh eggs. But, she warns against freezing too late: “The younger the woman, the higher the success rates. Research from Spain has shown that if a woman under 35 freezes around 12 eggs, she could have up to a 50% chance of success later.” There’s no magic number of eggs to freeze but some clinics recommend 20 if you’re under 37 and 30-plus if you’re older.

And the millennial tech boom is causing the rise of tech-fertility clinics in the US such as Extend, Prelude Fertility and Progyny – a new band of start-ups aiming to give women more time to have children. These clinics take a ‘wellbeing’ approach to egg-freezing, presenting it as an empowered lifestyle choice rather than something you do when you’re desperate to have a baby but there’s no man on the scene. The hope is a more positive, spa-like experience that aims to encourage more women to put their fertility on ice.

4. Rethink your birth control

More women than ever before are opting for the coil as their primary method of birth control to lighten periods and avoid artificial hormones (ie the Pill). But fertility experts urge us to reconsider the humble condom.

“Unless you’re actually trying for a baby, or you’re in a committed relationship and you’ve both been tested, condoms are more crucial than you’d think,” says natural fertility expert Emma Cannon, author of Fertile. “Chlamydia and gonorrhea are common causes of inflammation in the pelvic cavity (pelvic inflammatory disease or PID) and can lead to blocked fallopian tubes, which are linked to infertility, and repeated infections are particularly dangerous as they’re more likely to cause long-term scarring of the tubes. Using condoms is the best way to protect yourself.”

PID is harder to diagnose but your doctor can tell whether you may be affected based on symptoms and an examination – and both can be treated with antibiotics. Danish research has suggested the Pill may lower AMH and shrink ovaries. The effect is thought to last a few months – but being on the Pill and not having natural periods could mask problems with your cycle – and Cannon recommends getting to know what’s normal for you so you can spot any potential problems.

5. Analyse your lifestyle choices long-term

We all know that – generally speaking – smoking and drinking in excess aren’t good, and that if and when we start trying for a baby, it’s the thing experts say to cut down on. But when do you have to start doing that? A year before? A month? Or a decade?

“You don’t have to feel guilty about partying in your 20s – there’s no evidence it impacts on egg quality. It’s more about being mindful about the ways an unhealthy lifestyle can affect your body,” says Cannon. “The older you get, the more you’re affected by alcohol and drugs, as the protective mechanisms in your body reduce with age. The ovarian environment in which the eggs develop can be influenced by what you eat and drink and what chemicals you’re exposed to, and that may speed up ovarian ageing.”

So it’s a good idea to limit them more in your 30s, if children are on the agenda. The evidence also suggests “smoking can bring on menopause early because it reduces ovarian reserve,” says Raine-Fenning. “The ovary of a smoker looks older, both on ultrasound and to the naked eye. Smoking reduces blood supply to the ovaries and womb. There may also be hidden damage due to the toxins, such as nicotine and carbon monoxide, which impair egg quality and increase the risk of miscarriage if you do get pregnant.”

As for drinking, there’s conflicting research – the British Medical Journal found that drinking up to seven units a week had little effect on conception rates – but the less you drink, the better.

“A glass of wine with dinner is fine,” says Cannon. “But avoid binge drinking if possible. That’s linked with disruption to your cycle by creating a fluctuation in hormones and may make it harder to conceive in the longer term.”

6. Consider taking supplements

Italian research found that people who ate the most fruit, vegetables and pulses in the long term were more likely to conceive. But there are supplements you can take to safeguard your eggs for the future.

“Recent research suggests coenzyme Q10 (100mg a day) may help improve egg quality and reduce damage caused by free radicals,” says Raine-Fenning. Ubiquinol is the best absorbed form of co-enzyme Q10 – try Healthspan Ubiquinol 100mg (£37.95 for 60, healthspan.co.uk).

“And if you’re over 35, you could also try taking DHEA, a male steroid hormone produced by your adrenal glands, which starts to decline after 30 and may help improve egg quality,” adds Raine-Fenning. “There’s research to show taking DHEA supplements (75mg a day as 3 x 25mg doses) may help some women.” You can buy DHEA online – it isn’t licensed for sale in the UK so check with your doctor before you try it.

7. Rethink ‘family’ as you know it

In Denmark, one in 10 babies conceived with donor sperm is born to a single woman and elective single motherhood is on the rise in the UK, too. Even if you’re not ready to think about children, it could be time to start opening your mind to other ways of having a family. Treatment with donor sperm isn’t generally available on the NHS, as to qualify you have to have a medical condition that prevents you from conceiving. But you could have donor insemination or IVF at a private clinic.

It’s not cheap – donor sperm can cost between £600 and £1,000, and then insemination (inserting the sperm directly into your body around ovulation) can cost from £700, while you can expect to pay over £2,000 if you’re advised to have full IVF using donor sperm.

There’s a lot to think about before you go it alone, so for this reason, everyone undergoing treatment with donor sperm has to have counselling with a specialist therapist. Of course, you may decide that children aren’t for you – or just accept the fact that life may not pan out that way. It’s easy to focus on friends’ cute babies but how many of us think about having a teenager? Motherhood is often put on a pedestal but the fact is, one in four women will reach 45 without giving birth, and the number is expected to rise – I’m far from the only one without children in my group of friends.

All the fertility panic can put so much emphasis on having kids you feel you’ve failed at life if you haven’t done it – and that’s so far from the truth. But knowing that you’ve got time and you’re in control (to a certain point) is definitely empowering.

The latest in men's fertility

Three ways to test sperm…

1. Swimcount

This is a 30-minute DIY sperm test kit that measures semen quality as well as quantity at home. The device changes colour to indicate fertility status according to the World Health Organisation’s threshold for normal sperm. (£39.99, myswimcount.co.uk)

2. Yo

Turn your smartphone camera into a microscope to assess semen samples. Yo records a video of the live sperm then the accompanying iOS or Android app downloads an analysis of the sperm count along with what it means. (£40, yospermtest.com)

3. Spermcheck

Do away with smartphones with this test, which is similar to a pregnancy test in that it simply indicates a positive, negative or invalid result for active sperm. You can pick one up in Boots and it only takes 10 minutes. (£29.99, spermcheck.com)